ENDING DISCRIMINATION AGAINST
PEOPLE WITH MENTAL AND
SUBSTANCE USE DISORDERS

The Evidence for Stigma Change

Committee on the Science of Changing Behavioral Health Social Norms

Board on Behavioral, Cognitive, and Sensory Sciences

Division of Behavioral and Social Sciences and Education

THE NATIONAL ACADEMIES PRESS
Washington, DC
www.nap.edu

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This activity was supported by Contract No. HHSP233201400020B between the National Academy of Sciences and the U.S. Department of Health and Human Services/Assistant Secretary for Planning and Evaluation. Any opinions, findings, conclusions, or recommendations expressed in this publication do not necessarily reflect the views of the organization or agency that provided support for the project.

International Standard Book Number-13: 978-0-309-43912-1
International Standard Book Number-10: 0-309-43912-4
Digital Object Identifier: 10.17226/23442

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Suggested citation: National Academies of Sciences, Engineering, and Medicine. (2016). Ending Discrimination Against People with Mental and Substance Use Disorders: The Evidence for Stigma Change. Washington, DC: The National Academies Press. doi: 10.17226/23442.

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COMMITTEE ON THE SCIENCE OF CHANGING BEHAVIORAL HEALTH SOCIAL NORMS

DAVID H. WEGMAN (Chair), Department of Work and Environment, University of Massachusetts, Lowell (professor emeritus)

BETH ANGELL, School of Social Work, Rutgers, The State University of New Jersey

JOSEPH N. CAPELLA, Annenberg School for Communication, University of Pennsylvania

PATRICK W. CORRIGAN, Lewis College of Human Sciences, Illinois Institute of Technology

WILLIAM L. HOLZEMER, School of Nursing, Rutgers, The State University of New Jersey

CLARENCE E. JORDAN, Wellness and Recovery, Beacon Health Options, Boston, MA

ANNIE LANG, The Media School, College of Arts and Sciences, Indiana University

REBECCA PALPANT SHIMKETS, Carter Center Mental Health Program, The Rosalynn Carter Fellowships for Mental Health Journalism, Atlanta, GA

BERNICE A. PESCOSOLIDO, Department of Sociology, Indiana University

RUTH SHIM, Department of Psychiatry, Lenox Hill Hospital, New York, NY

ERIC R. WRIGHT, Department of Sociology, Georgia State University

LISA M. VANDEMARK, Study Director

JEANNE RIVARD, Senior Program Officer

VANESSA LAZAR, Research Associate

RENÉE L. WILSON GAINES, Senior Program Assistant

BOARD ON BEHAVIORAL, COGNITIVE, AND SENSORY SCIENCES

SUSAN T. FISKE (Chair), Department of Psychology and Woodrow Wilson School of Public and International Affairs, Princeton University

LAURA L. CARSTENSEN, Department of Psychology, Stanford University

JENNIFER S. COLE, Department of Linguistics, University of Illinois at Urbana–Champaign

JUDY DUBNO, Department of Otolaryngology–Head and Neck Surgery, Medical University of South Carolina

ROBERT L. GOLDSTONE, Department of Psychological and Brain Sciences, Indiana University

DANIEL R. ILGEN, Department of Psychology, Michigan State University

NINA G. JABLONSKI, Department of Anthropology, Pennsylvania State University

JAMES S. JACKSON, Institute for Social Research, University of Michigan

NANCY G. KANWISHER, Department of Brain and Cognitive Sciences, Massachusetts Institute of Technology

JANICE KIECOLT-GLASER, Department of Psychology, Ohio State University College of Medicine

BILL C. MAURER, School of Social Sciences, University of California, Irvine

JOHN MONAHAN, School of Law, University of Virginia

STEVEN E. PETERSEN, Department of Neurology and Neurological Surgery, School of Medicine, Washington University Medical School

DANA M. SMALL, Department of Psychiatry, Yale Medical School

TIMOTHY J. STRAUMAN, Department of Psychology and Neuroscience, Duke University

ALLAN R. WAGNER, Department of Psychology, Yale University

JEREMY M. WOLFE, Brigham and Women’s Hospital, Departments of Ophthalmology and Radiology, Harvard Medical School

BARBARA A. WANCHISEN, Director

Acknowledgments

This report has been reviewed in draft form by individuals chosen for their experience and expertise in accordance with procedures approved by the Report Review Committee of the National Academies of Sciences, Engineering, and Medicine. The purpose of this independent review is to provide candid and critical comments that will assist the institution in making its published report as sound as possible and to ensure that the report meets institutional standards for objectivity, evidence, and responsiveness to the study charge. The review comments and draft manuscript remain confidential to protect the integrity of the deliberative process.

We thank the following individuals for their review of this report: Mary E. Evans, College of Behavioral and Community Sciences, University of South Florida (emeritus); Jeffrey L. Geller, University of Massachusetts Medical School; Gary L. Kreps, Department of Communication, Center for Health and Risk Communication, George Mason University; Matthew W. Kreuter, Public Health and Health Communication Research Laboratory, The Brown School, Washington University in St. Louis; Bruce G. Link, Department of Sociology, University of California, Riverside; Bernadette Mazurek Melnyk, College of Nursing and College of Medicine, Ohio State University; Richard E. Nisbett, Department of Psychology, University of Michigan; Brian Primack, School of Health Sciences, University of Pittsburgh Medical Center; Jacqueline Tulsky, School of Medicine, University of California, San Francisco (emeritus); and Eduardo Vega, Mental Health Association of San Francisco.

Although the reviewers listed above have provided many construc-

tive comments and suggestions, they were not asked to endorse the conclusions or recommendations, nor did they see the final draft of the report before its release. The review of this report was overseen by John Monahan, University of Virginia School of Law, and Floyd E. Bloom, Molecular and Integrative Neuroscience Department, Scripps Research Institute. Appointed by the Academies, they were responsible for making certain that an independent examination of this report was carried out in accordance with institutional procedures and that all review comments were carefully considered. Responsibility for the final content of this report rests entirely with the authoring committee and the institution.

The committee also thanks a number of individuals who presented important content and contextual information for our consideration as speakers in the phase one workshops: Joan Austin, Indiana University; Kay Cofrancesco, Lung Cancer Alliance; Robert Edwards Whitley, McGill University; Sara Evans-Lacko, King’s College, London; Tony Foleno, Ad Council; Helena Hansen, New York University; Mark Hatzenbuehler, Columbia University; Anthony Jorm, University of Melbourne; Nathaniel Kendall-Taylor, The Frameworks Institute; Robin Koval, American Legacy Foundation; Alan I. Leshner, American Association for the Advancement of Science (emeritus); Bruce Link, Columbia University; Joe Powell, Association of Persons Affected by Addiction; Susan Rogers, National Mental Health Consumers’ Self-Help Clearinghouse; Joanne Silberner, University of Washington; Peggy Swarbrick, Rutgers University; Janet Turan, University of Alabama, Birmingham; Donna Vallone, American Legacy Foundation; Judith Warner, Center for American Progress; Phill Wilson, Black AIDS Institute; Jay A. Winsten, Harvard University; and Lawrence H. Yang, Columbia University.

The committee extends its appreciation to the following experts in sociology, psychology, public health, and nursing for providing papers that synthesized the evidence base on social norms, beliefs, attitudes, and behaviors related to mental illness and substance use disorders: Andrea Bink, Illinois Institute of Technology; Mark Hatzenbuehler, Columbia University; Bruce Link, Columbia University; Bianca Manago, Indiana University; Jennifer Merrill, Brown University; Peter Monti, Brown University; Matthew Pearson, University of New Mexico; Tracy Pugh, Columbia University; Lindsay Sheehan, Illinois Institute of Technology; Allison Webel, Case Western University; and Larry Yang, Columbia University.

Appreciation is also extended to Barbara Wanchisen, director of the Board on Behavioral, Cognitive, and Sensory Sciences, and Robert M. Hauser, executive director of the Division of Behavioral and Social Sciences and Education, for their leadership, guidance, and oversight of and support for the study; and the project team, Jeanne Rivard, Vanessa Lazar, and Renée L. Wilson Gaines. Finally, we thank the executive office reports

staff of the Division of Behavioral and Social Sciences and Education, especially Yvonne Wise and Eugenia Grohman, who provided valuable help with the editing and production of the report, and Kirsten Sampson Snyder, who managed the report review process.

David H. Wegman, Chair
Lisa M. Vandemark, Study Director
Committee on the Science of
Changing Behavioral Health Social Norms

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Contents

SUMMARY

1 INTRODUCTION

Context for the Study

Background and Committee Charge

Overview

Behavioral Health in the U.S. Context

The Broader U.S. Context

The Committee’s Work and the Report

2 UNDERSTANDING STIGMA OF MENTAL AND SUBSTANCE USE DISORDERS

Findings from Surveys of Public Knowledge and Norms

Factors That Influence Stigma

Consequences of Stigma

Targets and Interventions to Address Stigma

3 THE SCIENCE OF COMMUNICATION

Background

Setting Goals for Behavior Change

Reaching Target Audiences

Choosing a Message Source

Message Goals and Designs

Making the Most of the Message

Choosing the Medium Based on the Target

4 APPROACHES TO REDUCING STIGMA

Approaches and Strategies

Evidence from Large-Scale Campaigns

5 RESEARCH STRATEGIES

Formative Research

Intervention Research

Monitoring National Trends

Suggested Areas for Future Research

6 CONCLUSIONS AND RECOMMENDATIONS

Lessons Learned

Conclusions and Recommendations

REFERENCES

APPENDIXES

A Agendas: Public Workshops

B Biographical Sketches of Committee Members and Staff